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Background: In recent decades, the number of immunocompromised patients (ICPs) has increased significantly. ICPs have an impaired immune system, making them susceptible to complicated infections. To protect them from infections, ICPs are eligible to receive several medically indicated vaccines. To obtain insight into the uptake of these medically indicated vaccines, we determined the coverage of these vaccines in ICPs. Methods: This observational cohort study was conducted at the University Medical Centre Utrecht, the Netherlands, from September 2021 to April 2022. All adult ICPs admitted for COVID-19 were asked to complete a questionnaire on their vaccination history (pneumococcal, herpes zoster, human papillomavirus vaccination, influenza, and COVID-19 vaccines) and history of vaccine-preventable infections. In addition, patients’ vaccination history was reviewed in medical files. Results: A total of 115 patients completed the questionnaire and were included. Although all patients had an indication for pneumococcal vaccination, only 22 received it (19%). Coverage for herpes zoster was low (1%, 1/106 eligible patients). Coverage for human papillomavirus vaccination (HPV) was also low (40%, two out of five eligible patients). In contrast, 92% of patients received vaccination against SARS-CoV-2, and 77% of patients received seasonal influenza vaccination. Conclusions: Although coverage for influenza and COVID-19 vaccination was high in ICPs, coverage for other medically indicated vaccines was low. Identifying which factors contributed to high COVID-19 and influenza vaccine uptake can help to improve vaccination rates for the other recommended vaccines. Clear guidelines for clinicians and the removal of organizational obstacles are needed to improve vaccination coverage.

Background: In recent decades, the number of immunocompromised patients (ICPs) has increased significantly. ICPs have an impaired immune system, making them susceptible to complicated infections. To protect them from infections, ICPs are eligible to receive several medically indicated vaccines. To obtain insight into the uptake of these medically indicated vaccines, we determined the coverage of these vaccines in ICPs. Methods: This observational cohort study was conducted at the University Medical Centre Utrecht, the Netherlands, from September 2021 to April 2022. All adult ICPs admitted for COVID-19 were asked to complete a questionnaire on their vaccination history (pneumococcal, herpes zoster, human papillomavirus vaccination, influenza, and COVID-19 vaccines) and history of vaccine-preventable infections. In addition, patients' vaccination history was reviewed in medical files. Results: A total of 115 patients completed the questionnaire and were included. Although all patients had an indication for pneumococcal vaccination, only 22 received it (19%). Coverage for herpes zoster was low (1%, 1/106 eligible patients). Coverage for human papillomavirus vaccination (HPV) was also low (40%, two out of five eligible patients). In contrast, 92% of patients received vaccination against SARS-CoV-2, and 77% of patients received seasonal influenza vaccination. Conclusions: Although coverage for influenza and COVID-19 vaccination was high in ICPs, coverage for other medically indicated vaccines was low. Identifying which factors contributed to high COVID-19 and influenza vaccine uptake can help to improve vaccination rates for the other recommended vaccines. Clear guidelines for clinicians and the removal of organizational obstacles are needed to improve vaccination coverage. [ABSTRACT FROM AUTHOR]

Background: Specific vaccines are indicated for immunocompromised patients (ICPs) due to their vulnerability to infections. Recommendation of these vaccines by healthcare professionals (HCPs) is a crucial facilitator for vaccine uptake. Unfortunately, the responsibilities to recommend and administer these vaccines are not clearly allocated among HCPs involved in the care of adult ICPs. We aimed to evaluate HCPs’ opinions on directorship and their role in facilitating the uptake of medically indicated vaccines as a basis to improve vaccination practices. Methods: A cross-sectional survey was performed among in-hospital medical specialists (MSs), general practitioners (GPs), and public health specialists (PHSs) in the Netherlands to assess their opinion on directorship and the implementation of vaccination care. Additionally, perceived barriers, facilitators, and possible solutions to improve vaccine uptake were investigated. Results: In total, 306 HCPs completed the survey. HCPs almost unanimously (98%) reported that according to them, the primary treating physician is responsible for recommending medically indicated vaccines. Administering these vaccines was seen as a more shared responsibility. The most important barriers experienced by HCPs in recommending and administering were reimbursement problems, a lack of a national vaccination registration system, insufficient collaboration among HCPs, and logistical problems. MSs, GPs and PHSs all mentioned the same three solutions as important strategies to improve vaccination practices, i.e., reimbursement of vaccines, reliable and easily accessible registration of received vaccines, and arrangements for collaboration among the different HCPs that are involved in care. Conclusion: The improvement in vaccination practices in ICPs should focus on better collaboration among MSs, GPs, and PHSs, who should know each other’s expertise; clear agreement on responsibility; reimbursement for vaccines; and the availability of clear registration of vaccination history.

In Europe, water management is moving from flood defence to a risk management approach, which takes both the probability and the potential consequences of flooding into account. It is expected that climate change and socio-economic development will lead to an increase in flood risk in the Rhine basin. To optimize spatial planning and flood management measures, studies are needed that quantify future flood risks and estimate their uncertainties. In this paper, we estimated the current and future fluvial flood risk in 2030 for the entire Rhine basin in a scenario study. The change in value at risk is based on two land-use projections derived from a land-use model representing two different socio-economic scenarios. Potential damage was calculated by a damage model, and changes in flood probabilities were derived from two climate scenarios and hydrological modeling. We aggregated the results into seven sections along the Rhine. It was found that the annual expected damage in the Rhine basin may increase by between 54% and 230%, of which the major part (~ three-quarters) can be accounted for by climate change. The highest current potential damage can be found in the Netherlands (110 billion €), compared with the second (80 billion €) and third (62 billion €) highest values in two areas in Germany. Results further show that the area with the highest fluvial flood risk is located in the Lower Rhine in Nordrhein-Westfalen in Germany, and not in the Netherlands, as is often perceived. This is mainly due to the higher flood protection standards in the Netherlands as compared to Germany.

Due to the growing wish and necessity to simulate the possible effects of climate change on the discharge regime on large rivers such as the Rhine in Europe, there is a need for well performing hydrological models that can be applied in climate change scenario studies. There exists large variety in available models and there is an ongoing debate in research on rainfall-runoff modelling on whether or not physically based distributed models better represent observed discharges than conceptual lumped model approaches do. In addition, it is argued that Land Surface Models (LSMs) carry the potential to accurately estimate hydrological partitioning, because they solve the coupled water and energy balance. In this paper, the hydrological models HBV and VIC were compared for the Rhine basin by testing their performance in simulating discharge. Overall, the semi-distributed conceptual HBV model performed much better than the distributed land surface model VIC (E=0.62, r2=0.65 vs. E=0.31, r2=0.54 at Lobith). It is argued here that even for a well-documented river basin such as the Rhine, more complex modelling does not automatically lead to better results. Moreover, it is concluded that meteorological forcing data has a considerable influence on model performance, irrespectively to the type of model structure and the need for ground-based meteorological measurements is emphasized.

Background: Specific vaccines are indicated for immunocompromised patients (ICPs) due to their vulnerability to infections. Recommendation of these vaccines by healthcare professionals (HCPs) is a crucial facilitator for vaccine uptake. Unfortunately, the responsibilities to recommend and administer these vaccines are not clearly allocated among HCPs involved in the care of adult ICPs. We aimed to evaluate HCPs' opinions on directorship and their role in facilitating the uptake of medically indicated vaccines as a basis to improve vaccination practices. Methods: A cross-sectional survey was performed among in-hospital medical specialists (MSs), general practitioners (GPs), and public health specialists (PHSs) in the Netherlands to assess their opinion on directorship and the implementation of vaccination care. Additionally, perceived barriers, facilitators, and possible solutions to improve vaccine uptake were investigated. Results: In total, 306 HCPs completed the survey. HCPs almost unanimously (98%) reported that according to them, the primary treating physician is responsible for recommending medically indicated vaccines. Administering these vaccines was seen as a more shared responsibility. The most important barriers experienced by HCPs in recommending and administering were reimbursement problems, a lack of a national vaccination registration system, insufficient collaboration among HCPs, and logistical problems. MSs, GPs and PHSs all mentioned the same three solutions as important strategies to improve vaccination practices, i.e., reimbursement of vaccines, reliable and easily accessible registration of received vaccines, and arrangements for collaboration among the different HCPs that are involved in care. Conclusion: The improvement in vaccination practices in ICPs should focus on better collaboration among MSs, GPs, and PHSs, who should know each other's expertise; clear agreement on responsibility; reimbursement for vaccines; and the availability of clear registration of vaccination history. [ABSTRACT FROM AUTHOR]

Climate change will increase winter precipitation, and in combination with earlier snowmelt it will cause a shift in peak discharge in the Rhine basin from spring to winter. This will probably lead to an increase in the frequency and magnitude of extreme floods. In this paper we aim to enhance the simulation of future low-probability flood peak events in the Rhine basin using different climate change scenarios, and downscaling methods. We use the output of a regional climate model (RCM) and a weather generator to create long, resampled time series (1000 years) of climate change scenarios as input for hydrological (daily) and hydrodynamic (hourly) modeling. We applied this approach to three parallel modeling chains, where the transformation method from different resampled RCM outputs to the hydrological model varied (delta change approach, direct output, and bias-corrected output). On the basis of numerous 1000 year model simulations, the results indicate a basin-wide increase in peak discharge in 2050 of 8%-17% for probabilities between 1/10 and 1/1250 years. Furthermore, the results show that increasing the length of the climate data series using a weather generator reduced the statistical uncertainty when estimating low-probability flood peak events from 13% to 3%. We further conclude that bias-corrected direct RCM output is to be preferred over the delta change approach because it provides insight into geographical differences in discharge projections under climate change. Also, bias-corrected RCM output can simulate changes in the variance of temperature and rainfall and in the number of precipitation days, as changes in temporal structure are expected under climate change. These added values are of major importance when identifying future problem areas due to climate change and when planning potential adaptation measures. [ABSTRACT FROM AUTHOR]

Due to the growing wish and necessity to simulate the possible effects of climate change on the discharge regime on large rivers such as the Rhine in Europe, there is a need for well performing hydrological models that can be applied in climate change scenario studies. There exists large variety in available models and there is an ongoing debate in research on rainfall-runoff modelling on whether or not physically based distributed models better represent observed discharges than conceptual lumped model approaches do. In addition, it is argued that Land Surface Models (LSMs) carry the potential to accurately estimate hydrological partitioning, because they solve the coupled water and energy balance. In this paper, the hydrological models HBV and VIC were compared for the Rhine basin by testing their performance in simulating discharge. Overall, the semi-distributed conceptual HBV model performed much better than the distributed land surface model VIC (E=0.62, r²=0.65 vs. E=0.31, r²=0.54 at Lobith). It is argued here that even for a well-documented river basin such as the Rhine, more complex modelling does not automatically lead to better results. Moreover, it is concluded that meteorological forcing data has a considerable influence on model performance, irrespectively to the type of model structure and the need for ground-based meteorological measurements is emphasized. [ABSTRACT FROM AUTHOR]

Due to the growing wish and necessity to simulate the possible effects of climate change on the discharge regime on large rivers such as the Rhine in Europe, there is a need for well performing hydrological models that can be applied in climate change scenario studies. There exists large variety in available models and there is an ongoing debate in research on rainfall-runoff modelling on whether or not physically based distributed models better represent observed discharges than conceptual lumped model approaches do. In this paper, the hydrological models HBV and VIC were compared for the Rhine basin by testing their performance in simulating discharge. Overall, the semi-distributed conceptual HBV model performed much better than the distributed physically based VIC model (E=0.62, r2=0.65 vs. E=0.31, r2=0.54 at Lobith). It is argued here that even for a well-documented river basin such as the Rhine, more complex modelling does not automatically lead to better results. Moreover, it is concluded that meteorological forcing data has a considerable influence on model performance, irrespectively to the type of model structure and the need for ground-based meteorological measurements is emphasized. [ABSTRACT FROM AUTHOR]